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JOURNAL ARTICLE

Preoperative evaluation of patients with malignant pleural mesothelioma:
role of integrated CT-PET imaging.

Truong MT, Marom EM, Erasmus JJ.

PURPOSE: Malignant pleural mesothelioma (MPM) is an
uncommon neoplasm arising from mesothelial cells of the pleura. The prognosis
is poor with a median survival of 8 to 18 months after diagnosis. Multimodality
regimens combining chemotherapy, radiotherapy, immunotherapy, and surgery
are being used more frequently in patient management. Extrapleural pneumonectomy
is the surgical treatment of choice in 10% to 15% of patients who present
with resectable disease and is reported to prolong survival. Accurate
staging is important to distinguish patients who are resectable from those
requiring palliative therapy. Integrated computed tomography-positron
emission tomography (CT-PET) increases the accuracy of overall staging
in patients with MPM and significantly improves the selection of patients
for curative surgical resection. Specifically, CT-PET detects more extensive
disease involvement than that shown by other imaging modalities and is
particularly useful in identifying occult distant metastases. This article
reviews aspects of imaging performed in the initial staging of patients
with MPM according to the International Mesothelioma Interest Group staging
system and will emphasize the appropriate role of CT-PET imaging
in determining the T, N, and M descriptors.